| NPI | 1174387963 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L BOOKHARDT Authorized Official 798-487-6036 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2024-02-12 |
| Last Update Date | 2024-02-12 |